Americanly Yours

Despite overall disapproval with President Obama’s health care law, many of its provisions remain popular.  Perhaps the most popular provision in the law is one that prevents insurance companies from discriminating against customers based on “preexisting conditions.”  The logic is relatively simple at first glance: people with debilitating conditions will not be able to get coverage at affordable prices unless Congress mandates that insurance companies cannot discriminate against those with a preexisting condition.

We all know someone with a preexisting medical condition, be it cancer, diabetes, or pregnancy.  The fact that we all know someone who currently has or previously has had a preexisting condition is one reason why this provision is so popular.  After all, it is difficult to argue with someone who uses the emotional appeal of an aunt with cancer or a single pregnant woman who is uninsured.  Emotional appeals can be used to “justify” any side of any issue but they cannot prove anything.  Preexisting conditions can be tragically sad and are often not the fault of anyone, be it the victim or society as a whole.

There is a very important question that we must ask before we decide whether or not such a provision is a good idea: is it appropriate to punish someone who has done nothing wrong?

This is a very serious question.  If we decide that it is appropriate to punish someone who has committed no wrong, then we must not only answer why it is appropriate to punish the innocent, but who should punish the innocent and how severely they should be punished for their non-wrongs.

I do not see how any rational person who has thought about this question can decide that it is morally acceptable to punish a person who has done nothing wrong.

Therefore, if it is not appropriate to punish someone who has done nothing wrong, then we must absolutely reject the idea of Congress mandating that insurance companies not discriminate against those with preexisting conditions.  The reason for this is simple: forcing insurance companies to provide “affordable” coverage for those with preexisting conditions must result in increased costs for those of us without preexisting conditions.

Insurance is a vehicle which prices and protects against risk.  This is usually done by assigning people with similar characteristics to “risk pools” and charging them similar premiums.  In a free market for health insurance, 35 year old male smokers residing in the Chicago area who are overweight and have type 2 diabetes are likely to be placed in the same pool and will be charged the same or a similar monthly premium.  Under a system where insurance companies are prevented from discriminating against those with preexisting conditions, the previous group is merged with the group of 35 year old male smokers residing in the Chicago area who are overweight but do not have type 2 diabetes.  While this will result in lower premiums for those with type 2 diabetes, it will result in higher fees for those without the disease.

In other words, while preventing insurance companies from discriminating against those with preexisting conditions sounds like a noble idea, it ends up punishing those who have done no wrong.

I am sorry if you have a preexisting medical condition, I truly am, but unless you can conclude that your preexisting condition is my fault, you have absolutely no moral right to punish me for your condition.

I received the following comment from my friend John who recently started medical school.  The comment was posted on my Not Doing Nothing About Health Care post.

“I totally disagree with # 2. There is no way to control the quality of medical education in every country around the world. This would also completely flood the market with medical practitioners and drastically reduce doctors salaries which I am totally against. I don’t think reducing medical practitioners salaries is the right way to go. Why would anyone do 9 years of med school and residency and be on call all hours of the night if they were making less than they are now?? And on that note, would you want a surgeon trained somewhere you’ve never heard of in Tanzania cutting into you.. even if he charges 1/5 the price of an American?”

Here is my response:

John,

Thanks for the comment.

There is a very simple way to “control [for] the quality of medical education in every country around the world.”  This plan is completely workable if you force foreign doctors to take the same medical licensing exams that American doctors have to take.  This way, whether the doctor was from Canada, Tanzania, or somewhere Ive never heard of, he or she would have to be held to the same standards that all American doctors would.

As far as “drastically reduc[ing] doctors salaries,”  that wouldnt be the case either.  Remember, that part one of my plan would end all income taxes on doctors.  Given that the average doctor finds himself in the highest tax bracket, this would actually result in a massive increase in pay.  [Furthermore, it would save the doctor time, allowing him or her to relax or work more instead of having to figure out their taxes.]  When talking about reducing doctors’ pay, I think you are also forgetting the demand side of this equation.  The simple fact is that demand for medical care is rapidly rising.  A big part of this is because baby boomers are getting older and are requiring more care.  Allowing more doctors into America will result in better care for more Americans at a lower rate.  Yet, ending income taxes for doctors allows them to keep more money while charging less for services–a win-win situation.

Additionally, if we could ensure that doctors from foreign countries were held to the same standards as American trained doctors the cost of medical school might actually decrease.  Think about it–if you knew for a fact that medical schools in Asia, Europe, South America, or elsewhere were significantly cheaper, and you were able to go online and find the pass rates for student from these schools, you as an American might be more willing to attend one of these less expensive schools.

To sum up:  the goal is to increase supply without decreasing pay or quality.  That is why allowing foreign doctors into the country must be done while holding them accountable to the same medical standards as American trained doctors.  That is also why this must be accompanied by an end to taxes for doctors.

Americanly Yours,

Phred Barnet

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“We have to do something!”

This cry is sounded repeatedly by those who are demanding some type of health care reform from President Obama.

Its hard to argue with their logic.  After all, health care costs are soaring and [according to some] there are nearly 50 million Americans lacking health insurance (although they are not without health care itself). Insurance premiums are rising faster than income, and Medicare will run out of money in 2019, potentially leaving millions of retirees without coverage, or causing taxes or government borrowing to rise rapidly.

I agree that something needs to be done.  However, I disagree about what exactly should be done.  Even the proponents of the Congressional plan agree that it is far from perfect, but they continue to repeat the mantra that “we have to do something.”

Well, we do have to do something, right?

The American people arent so sure.  According to a new Rasmussen poll, 54% of American voters–a larger majority than the percentage of Americans who voted for President Obama–believe that passing no health care reform would be a better option than passing the plan currently before Congress.  Only 35% say that the current bill would be better than “doing nothing.”

And it is now being reported that the President has dropped his demand for a “public option.”  If this is true, it could leave behind an expensive bill that does little to change the current system.

This plan is being pushed through Congress at a rapid pace.  President Obama has set artificial deadlines for when he wants legislation on his desk, yet health care reform is a massively complex issue that a new administration shouldnt reasonably expect to tackle in such a short time.  How this Nation to decide on a complex long term health care reform plan in only a matter of weeks?

I am one of the 54% of American voters who prefers “doing nothing” over passing the current plan.  However, that doesnt mean I favor doing nothing in general.  Here are some of my ideas for health care reform:

1)  End (or significantly reduce) income taxes for individuals working as medical doctors, nurses, medical practitioners, etc.

Doing this could dramatically lower the costs of medical care.  Ending or cutting income taxes for medical workers will essentially allow them to earn the same amount of money for charging less for their services.  This would also encourage those considering becoming nurses or medical staff to return to school and become certified in their fields, as well as encourage older medical workers to work for several more years (if they are able to keep more of their earnings, they could be more willing to work longer).  While this could add to the National debt if spending is not cut, the Nation would save a considerable amount of money in added health care costs.  And of course, I would support this plan only if it included spending cuts to balance out the lost revenues.

2)  End (or significantly reduce) immigration restrictions for individuals working as medical doctors, nurses, medical practitioners, etc.

Ultimately, costs in any industry, including health care, are dependent on supply and demand.  Any doctor, nurse, x-ray technician, etc. who is able to speak English should be offered instant American citizenship.  There are large numbers of such people all over the world who are interested in becoming American citizens, but who are unable to do so because of current immigration laws.

3)  Allow insurance companies to sell plans across State lines.

Federal law currently prevents insurance companies from selling plans across State lines.  This is just plain illogical.  This leads to inefficiencies and increased costs for both the business and the consumer.  Imagine if cell phone companies had to comply with similar restrictions–a company like Verizon would be prevented from having a National plan, they would have to have a different plan and pricing scheme for each State and D.C, and the cell phone user’s costs would be higher as a result.  The same is true for health insurance.  Allowing insurance companies to sell plans across State lines would essentially create a National insurance market where customers could go online to a site like e-healthinsurance.com and select a plan from companies headquartered anywhere in the Nation.  Taking this step would also allow insurance companies to cut unnecessary staff–potentially passing savings on to consumers.  There is no reason for a company like Blue Cross to have to have 51 different organizations to create and price different insurance plans.

Remember that just because we “have to do something” does not mean that we should have to do “anything.”  There are good as well as bad reforms, just as there are good and bad treatments for any disease.  A doctor with a seriously ill patient should look at all the options and diagnose the patient carefully and as accurately as possible before treating the patient.  Treating the patient before diagnosing him and reviewing all of the options could be catastrophic.

Americanly Yours,

Phred Barnet

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